Endovascular treatment of blunt traumatic injuries of the subclavian and axillary arteries

Abstract

Introduction: Blunt trauma of the axillary and subclavian arteries is uncommon. Conventional surgery presents significant morbidity associated to the need of extensive exposure and challenging dissection through traumatized tissues. Endovascular treatment is an alternative that has increasingly been used in traumatic arterial injuries. This report presents three cases that were managed by endovascular techniques. Methods: We report the cases of three patients with blunt traumatic injuries of the subclavian and axillary arteries who were treated at our Institution in 2013 with endovascular techniques. Each case presented distinctly, resulting from different traumatic mechanisms and the therapeutical approach was adapted accordingly. Results: Case 1: A 68-year-old man was admitted with an acute limb ischemia of the left upper limb after a fall from his own walking height. A computerized tomography angiography demonstrated a dissection of the left subclavian artery. Resource to a proximal angioplasty with stent allowed the recovery of the limb perfusion fixating the flap. Case 2: A 34-year-old male who fell from a height of 8 m, with multiple costal arch fractures and the complete transection of the subclavian artery. In this case, a covered stent excluded the rupture. Case 3: A 45-year-old woman presented to our department with an acutely ischemic left upper limb with 3 days of progression after a distension of the scapuloh-umeral articulation. Although a digital amputation was ultimately necessary, hand-salvage was accomplished through thrombectomy and catheter-directed thrombolysis. Conclusion: Blunt trauma of the axillosubclavian arteries is rare and its diagnosis may be challenging. Endovascular treatment of blunt traumatic injuries of the subclavian and axillary

After a blunt trauma, xillary artery transection is repaired endovascularly with a stent graft.

“…The traditional method of repair is surgery, however this can be challenging for anatomical reasons and has the potential to result in life-and limbthreatening complications. [1] Thus, endovascular therapy offers a therapeutic alternative for the high-risk patient. There are case reports for the endovascular therapy of pseudoaneurysms with stent grafts, but there is little to no information.the boundaries.…”

Endovascular Repair of Axillary Artery Transection with a Stent Graft following Blunt Trauma

“…Surgical repair is considered the standard approach but can be difficult for anatomic reasons, with consequent limb and life-threatening complications. [1] Endovascular therapy thus provides an alternative for therapy in the high-risk patient. Case reports exist for the management of pseudoaneurysms with stent grafts, but little to no data exists for the endovascular treatment of transections in the extremities.…”